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Open Access Highly Accessed Research article

Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome

Alexandre R Marra12*, Michael B Edmond2, Richard P Wenzel2 and Gonzalo ML Bearman2

Author Affiliations

1 Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil

2 Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia, USA

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BMC Infectious Diseases 2007, 7:42  doi:10.1186/1471-2334-7-42

Published: 21 May 2007

Abstract

Background

Clostridium difficile-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting.

Methods

We performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units.

Results

Sixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score ≥3, gender, concurrent infection, and number of days with diarrhea before a positive C. difficile toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset (per 1-point increment, OR 1.40; CI95 1.13–1.75) and age (per 1-year increment, OR 1.10; CI95 1.02–1.19).

Conclusion

In ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death.